This really super-nice dog is thirteen years old. You can see that his beautiful chocolate coat is nicely accented by a lot of gray around the muzzle. Despite his gray hairs, he appears to be in very good physical condition generally. His coat is sleek, he is well muscled, eyes are clear, teeth are good, and he has lots of energy.
He also has this mongo-huge tumor on his paw. It has been rather slow growing, starting out no bigger than a marble around eighteen months ago. It's pretty big now, though — 3.5 cm by 7.5 cm. The owner has been putting off doing anything to it for two reasons.
One, it hasn't seemed to bother the dog. In fact, it still doesn't. Old Fido isn't the least bit lame or tender on the foot. Two, the dog is thirteen years old. He figured this was something the dog would die with, rather than die from. That is to say, it just seemed to be more of a cosmetic problem than a medical problem.
But, it just kept getting bigger… and bigger. Now he is getting a little worried about it. What if it "popped"? What if it's malignant (cancerous)? Those are real concerns. "What should I do?"
The first thing was to try to get an idea of what the mass is. I pierced it with a needle to try to aspirate some cells that I could examine under a microscope. Unfortunately, all I could come up with was red blood cells. This could mean that I just kept getting unlucky and nicking a capillary blood vessel instead of hitting solid tumor mass. I recall a case where this happened because it was a hemangioma – a tumor made up of abnormal blood vessel growth. You get a lot of blood out of those.
So, that was pretty much a bust. I could tell the owner that it's not a lipoma (a benign fatty lump), and it's not a fluid-filled cyst. The only way to tell what it is would be to take a piece of it (or all of it) and let a pathologist examine it microscopically.
Here's where we stand. Before we consider surgery, we need to find out if there are any deal-breakers. Step one is chest X-rays. If the dog has lungs full of lumps like this, we're not going to be accomplishing much by operating on his paw. Step two would be pre-operative risk factor assessment. Along with the chest X-rays (heart okay? lungs okay?), some bloodwork to evaluate liver and kidney function and to look for any evidence of tumor spread to other organs. At thirteen years old, I'd like to have an ECG also.
Surgery in this area is a little tricky. Ordinarily, there's not much loose skin to play with when you're that low on the limb. It can be difficult to close your incision and you can wind up with a long-term project getting the surgical wound to heal.
We might be able to use a lot of that skin that has been stretched by the tumor, providing that the tumor just "shells out" like the meat of a pecan. If we need to lose that skin along with the mass, then we will certainly have more problems. Lots of bandaging could be required.
So, should we or shouldn't we? Well, if his pre-op risk factor assessment looks okay, I'd say we should. Why is that? Am I a typical surgeon? "A chance to cut is a chance to cure". Do I just need the money? No doubt I do. But those aren't the reasons.
This thing just keeps growing. Sooner or later it is going to get traumatized or it's going to outgrow its blood supply. It's going to be open and draining and then we'll HAVE to do something. We're not going to just let it slop around bleeding and draining all over the house and getting infected and painful. We'll either have to fix it or euthanize the dog.
If we don't want to euthanize the dog (and we don't), then we're going to fix it. If we're going to fix it, then we should fix it now while the dog feels good and before it gets any bigger and harder to fix.
So, it's time for tumor removal.